Chapter 3 Case Study R. During the assessment, your patient states, "My doctor told me that I need to have genetic testing.
Here are the ampules I used to draw up the octreotide. In other words, you will frequently STATE, ELABORATE, ILLUSTRATE, AND EXEMPLIFY your points.
Notice when you become defensive when another person tries to point out a deficiency in your work, or your thinking. What did you learn about yourself?
What over-the-counter drug is the best choice to help prevent constipation? Submitted by The Link on March 8, - 4:
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Log in Sign up. Upgrade to remove ads. It is time to give Mrs. Garcia her meds. Lasix 20 mg p. Critical thinking practice problems 20 critical thinking practice problems tablets Wellbutrin mg p. The physician wants to know how many tablets critical thinking practice problems Percocet Mrs.
Garcia typically takes in one week. Garcia and her daughter report that she has been consistently taking 1 tablet of Percocet every 6 hours. What will you probleks the physician? It is and the aide on the unit notifies you that Mrs.
You review the chart and find the following order: Tylenol Elixir mg per 5 mL How many mL will you administer and what device will you use to measure the dosage? KCl 20 mEq p. KCl 40 mEq per 15 mL How many mL will you give per day? Imodium 1 mg per 5 mL How many mL will you give? Tagamet mg p. Tagamet mg per 5 mL How many mg will you give per day? He has a history of advanced metastatic rectal cancer.
Before critical thinking practice problems is transferred to the unit from the post-anesthesia care unit PACUyou must confirm PCA morphine settings with the PACU nurse. What are the six rights you will verbalize to reduce medication errors? Ross is transferred to the unit in stable condition. He has an NGT to low intermittent suction draining brownish red fluid. Surgical dressing is clean, dry, and intact, with minimal bloody drainage to colostomy and mucous fistula bags.
How do you respond when she asks, "What is medication reconciliation? Comparing the meds from home to the meds from the hospital. Making sure there are no duplications in medications or therapies. Which route of administration will be used? Which device can you ppractice to administer 1. How many tablespoons can one medicine cup hold? Differentiate between the sublingual and buccal routes of administration.
What should you do if you make a med error? Continually assess the patient, inform the physician, and document per agency policy. Discuss some special considerations for the elderly. Two thirds use Rx and OTC meds. Steps of tqm problem solving process changes slow function: Lowered body mass, change in mental status.
Problmes lower doses as a rule. May need special delivery devices, visual aid to read labels, and easy-open lids. Allow extra time for teaching; clients should demonstrate back what you taught them. You call the physician to alert her pgactice, despite the correct use of the PCA morphine, Mr.
Ross is having persistent, uncontrolled pain at a level the help novel essay questions 8 out of She gives you new orders to increase the PCA settings.
Before hanging up, you need to do what three things? You review the new order critical thinking practice problems have just received for Mr. Before sending the order to the pharmacy, you make sure it has what seven essential components? Organize the Following Antiemetic Orders in the Correct Tax planning for business income You have new orders to discontinue the NGT and advance Mr.
The physician writes the order: What components do you expect to see when reviewing the MAR? Ross is feeling nauseous after a popsicle and apple juice. You decide to medicate per MD order.
What are the 6 rights you will check when scanning bar codes on Mr. List critical thinking practice problems uses for the MAR. What types of systems are the Pyxis and Omnicel? Computer-Controlled Dispensing or Automated dispensing system ADS. What will the nurse do criticql Check the orders and give the patient the requested pain medication.
Provide comfort measures to the patient. Evaluate the effectiveness critical thinking practice problems previous pain medications. The day shift charge nurse is making rounds. A patient tells the nurse that crirical night shift nurse never gave him his medication, which was due at What will the nurse do first to determine whether the medication was given? Call the night nurse at home. Check the medication administration record MAR. A nurse makes an error when administering medications to a patient.
Which action by the nurse requires the supervising nurse to intervene? Completes an incident report. Informs the prescriber of the error. Documents adverse effects to the medication error. Records completion of an incident report in the medical chart. The nurse is preparing thinkung administer a transdermal patch to a patient and finds that the critical thinking practice problems already has a medication patch on his right upper chest.
What will the nurse do? Remove the old medication patch and notify the health care provider. Apply the new patch without removing the old one. Remove the old patch and apply the new patch in the same spot.
Remove the old patch and apply the new critical thinking practice problems to a different, clean area. Patch must be on alternating sites Always remove the old patch before adding a new one Important: The nurse is giving a medication that has a high first-pass effect.
The health care provider has changed the route from IV to PO. The nurse expects the oral dose to be A. May have 20mg with an IV may not go through the liver prlblems may need to have 40mg or 60mg PO absolutely goes through the liver because of crirical first-pass effect.
A patient is vhdl signal assignment hexadecimal of severe pain and has orders for morphine sulfate. The nurse knows that the route that would give the slowest pain relief would be which route?
The mouth has to go through the GI tract. When teaching a pregnant woman about the use of drugs during pregnancy, which statement will the nurse include? Exposure of the fetus to drugs is most detrimental during the second trimester of pregnancy. Pregnant women must never take drugs to control high blood pressure.
Drug transfer to a fetus is most likely to occur during the last trimester of pregnancy. A fetus is at greatest risk for drug-induced developmental defects during the second trimester of pregnancy.
Higher volume of critical thinking practice problems Higher "surface area" of the baby. A patient critical thinking practice problems prescribed ibuprofen mg PO every 4 hours as needed for pain.
The pharmacy sends up enteric-coated tablets, but the patient refuses the tablets, critical thinking practice problems that she cannot swallow pills.
Crush the tablets and mix them with applesauce or pudding. Call the critical thinking practice problems and ask for the liquid form of the medication. Call the pharmacy and ask for the IV form of the medication. Encourage the patient to try to swallow the tninking. Can NEVER EVER crush enteric-coated tables Critical thinking practice problems and PO are two different ways of entry.
When administering medications to pediatric patients, the nurse understands that the dosage calculations for pediatric patients are different than for adults because pediatric patients A.
What does the nurse identify as a pharmacokinetic change that occurs in older adults? Gastric pH is more acidic. Fat content is decreased because of increased lean body mass. There is increased production of proteins by the liver. The number of intact nephrons is decreased. Which racial group is predicted to be nearly one in three U. What are some cultural considerations?
African Americans respond better to diuretics than to beta blockers. African Americans do not respond to diltiazem. Single-drug therapy is effective for African Americans.
Hypertension is uncommon in the African-American population. A research group is conducting an investigational drug study on a promising new drug for osteoporosis. It has been difficult to find research participants who meet the criteria. Just before the conclusion of the study, four participants approach the researchers and express their desire to withdraw from the study.
The researcher should first A. This is an example of A. The nurse should A. Nurse cannot be forced but should inform their - supervisor Manager makes new assignment. In a IOM study, it was estimated that some form of medication error resulted in harm to how many patients?
The nurse is administering a drug that has been ordered as follows: Give 10 mg because June 1 is an odd-numbered day. Hold the dose creative essay titles for macbeth the next odd-numbered day.
Change the order to read: Consult the prescriber to verify that the dose should alternate each day, no matter whether the day is odd or even numbered. Consult the prescriber to verify that the dose should alternate each day, no matter whether the day is odd or even numbered We do not have the authority to change the order. The nursing student realizes that she critical thinking practice problems given a patient a double dose of an antihypertensive medication.
The tablet was supposed to be cut in half, but the student forgot and administered the entire tablet. What should the student nurse do first?
Notify the clinical faculty. Continue to monitor the patient. The nurse is caring for an year-old dissertations on educational measurement and evaluation in the hospital and teaching him how to use an inhaler.
His year-old wife attends the teaching sessions, and their daughter comes in to visit in the evenings. The patient is having trouble remembering the steps. It bsbsmb402 plan small business finances the critical thinking practice problems who needs to know this information in the end.
A patient with newly diagnosed type 1 diabetes mellitus has completed a diabetes education program. Which nursing diagnosis will the nurse assign the patient? Thinkjng things to document critcial to patient education: Learner critical thinking practice problems "Willing to learn" Outcomes "Pt able to self-inject" Content provided "Information on step-by-step insulin injection given" Strategies used "Return demonstration critical thinking practice problems Patient response to the teaching session "Pt states this was very critical thinking practice problems Overall evaluation of learning Did they or did they not learn?
What steps do we take from here? A nurse is providing patient teaching for a community health center that critical thinking practice problems a primarily Portuguese population. The nurse would best serve this patient population by: If you are always going to critical thinking practice problems there, it makes sense to pick up the language.
After providing education regarding medications to a patient who has been newly diagnosed with type 2 diabetes mellitus, the nurse would use which part of the nursing process to assess whether the patient understands these new instructions? Evaluation Need to evaluate whether or not they understood Assessment happens very first, are they ready? Criteria for Over-The-Counter status: Benefits of correct usage electrical engineering research proposal sample pdf outweigh risks Consumer must be able to easily: Some reclassified OTC drugs: OTC medications now account for about pactice percent of all critical thinking practice problems used in the United States?
A year-old man is taking OTC antacids for relief of indigestion. Critixal tells the nurse that he consumes at least one bottle a week and has done so for more than 1 month because "it works for me. The nurse associates use of which OTC medication with the development of hepatotoxicity?
Acetylsalicylic acid aspirin B. Critical thinking practice problems Tylenol Liver A. A patient tells the nurse that he wants to stop taking his antilipemic drugs and start taking garlic to lower his cholesterol. What are the components of a cultural assessment? Language spoken Is an interpreter needed? Why or why not? Response to illness Response to medical treatment Religious beliefs Critical thinking practice problems i.
Restrictions no pork, no pork-derived critical thinking practice problems. A participant tells the nurse, "I have high blood pressure and hardening of my arteries. I go to the doctor and take prescription pills, but I have added herbs because they are natural and totally safe.
We need critical thinking practice problems explain to our patient the interactions between prescribed medicines and herbals. A participant tells the nurse that she is seeing her family physician for treatment of depression and that she has been taking a thiking drug.
The participant tells the nurse that she wants to start to take St. The nurse bases his response based on the fact that use of St. A how to write a discussion paper outline tells the nurse that she would like to start taking gingko.
Before starting this herb, it is most important for the nurse to ask the patient if she is taking which type of medication? Any kind of anticoagulants Can increase the chance of bleeding. Which statement regarding gene therapy is accurate? Gene therapy is commonly used for the treatment of disease.
Bacteria are used for gene transfer. I know they were doing genetic testing on my mother. Ask the patient about the test results when the daughter enters the room. Chapter 1 Case Study Dollie, a year-old social worker, is visiting the clinic today for a physical examination. She states that she and her husband want to "start a family," but she has not had a physical for several years.
She was told when she was 22 years of age that she had "anemia" and was given iron tablets, but Dollie states that she has not taken them for years. She said she "felt better" and did not think she needed them. She denies any use of tobacco and thinkijg drugs; she states that she may have a drink thinkingg dinner once or twice a month. She uses tea tree oil on her face twice a day to reduce acne breakouts. She denies using any other drugs.
What other questions does the nurse need to ask during critical thinking practice problems assessment phase? After laboratory work is performed, Dollie is told that she is slightly anemic. The prescriber recommends that she resume taking iron supplements as well as folic acid. Dollie is given a prescription that reads as follows: What should be done? I hate to essay about homework on weekends pills.
Answers may vary, but would include: Answers critial vary, but considering that she had stopped taking a medication years before, tally assignment question that she states that she is willing to improve her critical thinking practice problems, appropriate nursing diagnoses may include: Think about the "Nine Rights"!
How often does this medication need to be taken? Should it be taken with meals or on an empty stomach? The critical thinking practice problems will need to critical thinking practice problems the licensed prescriber to clarify the prescription.
The frequency of the medication will certainly affect the dosage critiacl ultimately receives each day. Dollie has the right to refuse to take the medication. If the critkcal of refusal is known, then the nursing care plan may be revised and further actions implemented, such as education about the purpose of the drug and how critical thinking practice problems manage side effects, as well as other concerns raised by thinknig patient. Chapter 1 Critical Thinking 1. When medications were administered crtical the night shift, a patient refused to take his dose of an antibiotic, claiming that he had just taken it.
What is the critical thinking practice problems action by the nurse to maintain patient safety? During a busy shift, the nurse notes that the chart of a newly admitted patient has a few orders for various medications and diagnostic tests that were taken by telephone by another nurse. How does the nurse go about giving this drug? Explain the best action to take in this situation. Never assume that the patient is unaware of his or her medication; always double-check to thniking safe.
If all records and orders have been checked, and the nurse is certain that the drug has not been given, then the nurse proceeds with medication administration. A simple explanation could then be given to the patient. Because this is a newly admitted patient, it would be models for writers short essays for composition eleventh edition to perform an assessment before giving any medications.
However, business plan for jewellery business opportunities the order is stat, meaning to give immediately, the assessment has to be brief and focused. Check for signs of fluid retention pedal edemaask about urine output and function, and listen to breath and heart sounds. Critical thinking practice problems not forget to assess for drug allergies and other drug reactions.
However, the stat order is missing something—a route. Critical thinking practice problems assume that a problms is to be given by mouth. Even though this patient was just admitted and may or may not have an intravenous line, the best action is to clarify the route by which this drug should be given. The order was taken by telephone by another nurse, so you can ask the nurse whether a route was specified when the nurse spoke to the prescriber.
If not, the prescriber must be contacted right away for clarification. To streamline things, the order can be checked by another nurse or, in some facilities, the pharmacist, while you are performing the assessment. Chapter 2 Case Study Four patients with criticak are receiving a form of nitroglycerin, as follows: You may refer to the section on nitroglycerin in Chapter 23 or to a nursing drug handbook to answer these questions. For each patient, critical thinking practice problems the rationale for the route or form of drug that was chosen.
Which forms have immediate action? Why would this be important? Which form or forms are most affected by the first-pass effect? What would happen if Mrs. Oral, extended-release capsule critical thinking practice problems form provides medication for a long duration extended-release form to critifal angina pain.
Transdermal dosage form provides medication for a long duration and allows for steady dose of medication; it is also used to prevent angina pain. Sublingual dosage form is critical thinking practice problems quickly in the sublingual area, with onset within minutes to treat acute angina pain. Intravenous dosage form has an onset time of 1 to 2 minutes and problemss be adjusted according to his response to free sample consulting business plan pdf drug.
The oral form critical thinking practice problems by Mrs. The metabolism by liver enzymes may result in reduced drug effects; however, the dosage of the drug will reflect the expected first-pass effect.
The drug may be inactivated in the stomach by gastric acids, or a higher dose critical thinking practice problems the drug may be available for absorption into the bloodstream. As a result, the intended therapeutic effect angina prevention would not occur. The dose would enter the gastrointestinal tract and face destruction by gastric juices. As a result, the medication would be ineffective in treating an acute episode of chest pain.
Chapter 2 Critical Finance dissertation topics oxford 1. Which route of administration would you expect to be the best choice for this patient?
You are administering medications to a patient who had an enteral tube tginking 2 days earlier for continuous feedings. As you review the medication list, you note that one drug is an enteric-coated tablet ordered to be given twice a day.
What is the best action regarding giving this drug to this patient? Intravenous therapy would be most appropriate because it allows immediate access by the drug to the bloodstream. With intramuscular IM or subcutaneous injectable forms of medications, absorption of the criticwl from the vascular area within a muscle or within subcutaneous tissues is required before absorption into the bloodstream.
In a patient who is in shock or has decreased cardiac output or decreased peripheral circulation, the IM montgomery county public school assignment locator would not be as well absorbed.
Lastly, criticcal forms may not be appropriate because of the longer absorption time via the gastrointestinal tract, and the patient may not be conscious enough to take oral drugs because of his critical condition. Crushing an enteric-coated tablet may cause disruption of the critical thinking practice problems that is designed to protect the stomach lining from the local effects of the medication, or it may cause the drug to be prematurely destroyed by stomach acid.
The nurse needs to consult the pharmacist to ask about the availability of the drug in a liquid form that can be given safely through the enteric tube.
If necessary, the licensed prescriber may have to be contacted to thikning the medication order to an appropriate form. Chapter 3 Case Study R. She uses the pharmacy at a large discount store but also has prescriptions filled at a nearby pharmacy, which she uses when she does not feel like going into the larger store.
Her medication list is as follows: Thiazide diuretic, prescribed for peripheral edema Potassium tablets, prescribed to prevent hypokalemia Beta blocker, prescribed for hypertension Warfarin, taken every evening because of a history of deep vein thrombosis Multivitamin tablet for seniors 1.
What medications critical thinking practice problems cause problems for R. What measures can be taken to reduce these problems? Two weeks later, she notices that she has increased bruising on her arms and legs, and that her gums bleed slightly when she brushes her teeth. How could this problem have been prevented? Polypharmacy is a concern when more than one medication is taken. For a patient taking five medications, the chance of a drug interaction is high.
Specifically, critical thinking practice problems thiazide diuretic may cause electrolyte imbalances and interesting critical thinking questions the potassium tablets may also contribute to electrolyte disturbances if her serum potassium levels critical thinking practice problems not monitored closely. The beta blocker may cause bradycardia, hypotension, and even heart failure if critical thinking practice problems is not monitored while on this medication.
The warfarin, an anticoagulant, may math venn diagram problems worksheet thinkihg of bleeding, both minor and major. In addition, many drugs interact with warfarin. It is essential that the specialists communicate with each other regarding what therapy and drugs are prescribed for R.
It would also be helpful critical thinking practice problems her to have all of her prescriptions at probleme pharmacy. This would allow one pharmacist to keep track of her ordered medications and to look for any potential drug interactions or other concerns that may occur when she receives new prescriptions.
Many over-the-counter medications must not be taken with prescribed medications. Nonsteroidal anti-inflammatory drugs may interfere with the action of the warfarin, causing increased bleeding tendencies R.
For more information see Table Chapter 3 Critical Thinking 1. A mother calls the thibking to ask how to give a tablet to her 4-year-old son. Crihical woman critica, her third trimester of critical thinking practice problems is having a checkup and asks for aspirin for a headache. First, the nurse needs to make sure that the mother does not "force" the child to take the medication. There are better ways to ensure that the child takes the medication. Make sure that the medication is in a form that can be chewed or crushed.
Enteric-coated or slow-release forms must not be crushed. If the tablet can be crushed, the nurse can instruct the mother to mix the crushed tablet in a food, such as pudding, sherbet, or ice cream, and then follow with a glass of juice or water. Instruct the mother not to mix the medication in an essential food, such as orange juice or milk.
Of course, praising the child after the child takes the medication is also important. If the child still refuses, contact the prescriber for another form of the medication, if possible i.
The nurse will check a drug reference and find that aspirin is a pregnancy category D drug if given as a full dose in the third trimester of pregnancy.
This means that critical thinking practice problems is possible fetal risk in humans, and use of the drug would be decided on after considering the benefit versus the risk of the drug.
There are other choices for headache treatment that fall into safer pregnancy categories. The nurse will advise her not to take the aspirin and to consult prroblems prescriber for an acceptable alternative for treatment of the headache. Chapter 4 Case Study A patient on the cardiac telemetry criyical has had a serious heart condition for years and has been through every known protocol for treatment.
Critical thinking practice problems cardiologist has admitted him to a telemetry unit for observation during a trial of a new investigational drug. The patient exclaims, "I have high hopes for this drug. What is the best autobiography assignment for high school for why is it important for a small business to write a business plan research nurse to answer this statement?
The physician meets with the patient and the research nurse to explain the medication and how the double-blind experimental drug study will work. The physician then asks critical thinking practice problems research nurse to have the patient sign the consent form. Should the research nurse continue with getting the consent form signed? The patient tells the research nurse, "How can I make sure I have the critical thinking practice problems drug and not the fake drug?
I really want to see if it will help my situation. In fact, I feel worse. What do I do? Often they have the misconception that because an investigational drug is new it must automatically thining better than existing forms of therapy.
The nurse crritical to critical thinking practice problems the patient what critical thinking practice problems cardiac physician has told him about this new drug fhinking what to expect, and clear any possible misconceptions that the patient may have.
No, the consent cannot be "informed" consent if pracitce patient continues to express questions about the investigation. In a double-blind research study, both the investigator s and the subjects are purposely unaware of whether the substance administered is the drug under study or a placebo. This method eliminates bias on the part of both the investigator and the subject.
Because of this design, there is no way to guarantee that critical thinking practice problems patient critical thinking practice problems receive the experimental drug. The nurse needs to explain the design and purpose of a "double-blind" study and answer any other questions the patient may have.
During the explanation session, the physician critical thinking practice problems have stressed to the patient criticap involvement in the experimental drug study 5th grade math solving equations truly voluntary and that the patient had the research paper on banking frauds to either decline to participate or quit the study at any time, without affecting any previously agreed-upon health care services.
Critical thinking practice problems 4 Critical Thinking 1. During a busy shift, the nurse is called to the telephone to speak to a family member of Mrs. Is she going to die? The nurse is assessing a newly admitted year-old woman. During the assessment, the nurse finds that the patient is wearing a copper ring around her left ankle.
The nurse must answer under the guidelines of HIPAA Health Insurance Portability critical thinking practice problems Accountability Act. First, ask the patient the purpose of the copper ring—is it decorative or does it have a medicinal purpose? Then discuss with the patient how the ring is affecting the skin around the ankle. Chapter 5 Case Study During your busy clinical day as a student nurse, the staff nurse assigned to your patient comes to you and says, "Would you like to give this injection?
It needs to be given as soon as possible, critical thinking practice problems I drew it up for you to save time. Should you give this medication "now," as ordered? The physician ordered, "Octreotide, mcg now, subcutaneously, then mcg every 8 hours as needed. Here are the ampules I used to draw up the octreotide.
Be quick—your patient needs it now! Together you read the electronic order and then check the ampules. If the critical thinking practice problems drew up 2 mL from business budget planning xls two ampules, how much octreotide is in the syringe?
How does this amount compare with the amount on the order? What would have happened if you had given the injection? Consult a nursing drug handbook if needed. What needs to be done at this point?
What contributed to this potential medication error, and how can it be prevented in the future? No, you should not give the medication "now! Most importantly, proglems are a nursing student and medication administration is done under the supervision of your instructor. Probpems is when errors occur. The 2 mL, coming from both ampules, would equal mcg. The order was for mcg. The syringe contains mcg, which is mcg over the ordered amount!
A potentially serious medication error that violates the "right dose" could have occurred. The patient would have received mcg, five times more than the ordered amount! It is possible that the patient would experience more severe instances of the expected side effects, such as diarrhea, nausea, abdominal pain, headache, and pain at the injection site.
The patient would have to be closely monitored for these and other unexpected effects if the overdose had been given. At this point, the first thing to do is to give the patient the "now" order of mcg of Sandostatin.
The patient must then be monitored critical thinking practice problems for both therapeutic and adverse effects. No actual medication error occurred, but because the nurse was rushed, the wrong critical thinking practice problems was chosen to draw up into the syringe.
Being in a rush and not taking the time to do careful checks contributed to this critical thinking practice problems medication error. If the nurse had taken the time to check the dose three times, the discrepancy would have homework desk and chair set caught.
It is possible that a systems problem contributed to this potential error. The "identical" boxes of the same medication, all with different doses, need to be marked in such critical thinking practice problems way that the nurse can easily distinguish among the differing dose amounts. Chapter 5 Critical Thinking 1. I just took the whole tablet! The order was for 25 mg, a half-tablet, and the entire mg tablet was given.
At this time, what would the nurse need to say to critical thinking practice problems patient? The nurse is reviewing the orders on a newly admitted patient and reads this order: The nurse must acknowledge the wrong dose immediately and honestly, rather than trying to ignore or cover crltical the error.
This patient was aware of the error from the start. The nurse has an ethical and legal responsibility critical thinking practice problems acknowledge and report the error. Patient safety is most important in this situation, and the patient needs to be told what happened. The order monthly homework assignment sheet template written as follows: Humalog insulin, free small business plan outline template q.
The nurse notes the following issues: The nurse needs to clarify this order with the prescriber before administering the insulin. Chapter 6 Case Study M. As part of his medical therapy, he is started on the oral anticoagulant warfarin Coumadin. His wife reports that he has some trouble hearing smude assignments afi refuses to poblems getting hearing aids.
In addition, this is his first illness, and his wife states that he has "always hated taking medications. What will the nurse assess, including possible barriers to learning, before teaching?
Formulate an education-related nursing diagnosis for this patient based on the information given above. In critical thinking practice problems, provide at least three examples of outcome criteria for the nursing diagnosis. What critical thinking practice problems strategies will the nurse plan to use, considering any blank business plan forms changes the patient may have?
Anxiety may be another barrier. However, having some anxiety may be a good motivation for learning. The nurse needs to assess sample cover page for essay apa belief systems regarding health and his role in his own health. If the patient does not value medications, he may not critical thinking practice problems pracgice as prescribed. As a retired librarian, he is likely to conduct his own search for information regarding his health crtical medications.
Therefore, the nurse needs to critical thinking practice problems material critcial thoroughly explains the prkblems for the drug therapy, possible adverse effects, and precautions he must take while on an anticoagulant. Refer to the section "Assessment of Learning Needs Related critical thinking practice problems Drug Therapy" for more information.
There may be a few possible answers, but one main example based on the information provided would be deficient knowledge regarding anticoagulant therapy. Noncompliance may be an issue later if he decides not to follow the anticoagulant therapy, but it does not yet exist as the therapy is just beginning and he is cosmetic surgery essay against to try the medication. Examples of outcome criteria for the above nursing diagnosis would be: The patient is known to have reduced hearing, but he refuses to wear hearing aids.
It is possible that he has impacted cerumen ear wax and that removal of it may improve his hearing. The nurse should sit on the critical thinking practice problems of the ear where the patient has the best hearing and speak distinctly and critical thinking practice problems with careful articulation of words and a lower-pitch voice. Keep the room quiet, with no extraneous homework for pre k apples or other distractions.
Shouting is not necessary. Keep in mind that the patient may also have age-related vision changes that will require visual aids with bright, large-print material to be used when teaching. Nonglare lighting is ideal, with no contrasts of lights. Other tips may be found in Table Chapter 6 Critical Thinking 1.
A nurse has been trying to communicate with a patient who does not speak English, but so far none of the communication techniques has been successful. You may need to look up the drug in the textbook if you are not familiar with it. Critcial patient has had hip replacement surgery and will be going home in a few days. The surgeon has requested that the nurses teach the patient and a family member how to give subcutaneous injections of the how to write good conclusions for persuasive essays heparin that will be prescribed for him after his discharge.
Most plans will reflect the use of critical thinking practice problems interpreter, but more importantly, the plan of care needs to reflect an individualized approach to educating the patient about the toxic effects of this medication. Include family members, also, if at all possible.
The following list provides a simple guideline for assessment crtiical implementation and the other phases that depend on the information assessed. In addition, this drug should not be taken with bran products. For more information please check the information on digoxin in Chapter The priority is to start education as soon as ordered.
Do not wait until the patient has been discharged. The patient and family member will need to have several teaching sessions, including return demonstrations of injections, before the patient critical thinking practice problems home. Waiting until the time of discharge does not allow sufficient time to present information and to verify correct technique. Plus, the patient will be distracted by the excitement of going home, and in a hurry to leave.
Chapter 7 Case Study J. As he completes the paperwork, he asks the nurse, "The form is asking about my medications. Do you need to know about these? How should the nurse answer J. On the form, J.
Examine the products on J. You may need to refer to descriptions of the individual herbal products see the inside back cover for a complete listing of Safety: Herbal Therapies and Dietary Supplements boxes located throughout the textbook or to the appropriate drug chapters for more information.
What do you think has happened? Upon further questioning, J. What concerns, if any, are there about this? Critical thinking practice problems is important to review all medications and herbal products or dietary supplements that a patient may tjinking example of a personal essay for camp america. Interactions can occur with all products taken, whether they are prescription or nonprescription or herbal products.
Patients may need to be prompted to share information about over-the-counter OTC medications and herbals because they may not see these as "real drugs.
The nurse notes numerous critical thinking practice problems concerns about the effects of several of these products on blood coagulation. This may be a possible explanation for the bruising. The aspirin, because of its antiplatelet action, may prolong bleeding times. The ginkgo may interact with the aspirin and nonsteroidal anti-inflammatory drugs NSAIDsresulting in increased bleeding tendencies. The nurse needs to explore whether the daily aspirin was prescribed by a health care provider or if the patient decided to take the daily aspirin on his own.
Another major concern with this mix of herbals and OTC medications is the effect of the aspirin and NSAIDs on the gastric lining. Prolonged use of these drugs may lead to erosive gastritis and even gastric ulcers due to the destruction of the gastric ged essay topics examples. This condition could lead to dangerous gastrointestinal bleeding if his blood critical thinking practice problems in an anticoagulated state from the cgitical and herbal products.
Also, the nurse needs to note that the usual OTC dose of ibuprofen is one or two tablets crltical dose, not three to four as J.
The ginseng, even though it may be used to improve physical endurance and concentration as well as to reduce stress, may have the adverse effects of palpitations, anxiety, insomnia, nausea, and vomiting. These effects may interfere with sleep. He is taking valerian, which is commonly used to aid in sleep, but it may also cause stomach upset and even restlessness. In addition, using it with other drugs criticaal known critical thinking practice problems effects, such as the Benadryl, may result in excessive sedation.
This could be extremely dangerous if he tries to drive while taking these medications or takes them with alcohol. The ginkgo, ginseng, and critifal herbal products all may cause stomach upset as adverse effects. Could these be the source of his "acid stomach"? In addition, as mentioned earlier, the combination of aspirin and NSAIDs may actually contribute to the development of a gastric ulcer. The nurse needs to further assess J.
One problem with self-medication with OTC products is that patients may delay treatment for a critical thinking practice problems problem—in this case, a possible gastric ulcer. Chapter 7 Critical Thinking 1. Critical thinking practice problems nurse is critical thinking practice problems over-the-counter drugs and herbal products with neighbors.
One neighbor comments, "Oh, the over-the-counter problwms and herbals are safe. A patient tells critical thinking practice problems clinic nurse that he has been taking a "blood thinner" for several months and wants to critical thinking practice problems about taking garlic capsules to reduce his blood pressure.
He says his sister uses it and it "works wonders. You may need to look up the drug warfarin and the smu statistics assignments product elsewhere in the textbook. The neighbor is incorrect. The nurse needs to mention that there are many adverse effects and significant drug interactions of over-the-counter drugs and herbal products. Just because a drug is sold over the counter does not guarantee that it is risk free.
With herbal products, it is important to know that, unlike prescription drugs, these drugs are not monitored and regulated by the FDA. When shopping for herbal products, look for critical thinking practice problems that meet certain voluntary standards for quality.
The nurse needs to discuss the fact that herbal products are not necessarily safe just because they are readily available. In the United States, herbal products are not regulated as closely as are prescription and over-the-counter medications. If the patient how to do problem solving with similar figures the garlic product with him, help him to read the label that has the disclaimers and other information on it.
The nurse needs to tell him that garlic products may interfere with the action of the warfarin, leading to increased bleeding. Other drug interactions may occur with garlic also. It is important that he understand that herbal products can have harmful effects if taken without regard people that do your homework for you his current drug therapy.
Whenever I take it, it just knocks me out! Does the patient gre analytical writing topics with critical thinking practice problems an actual allergy to codeine? What else could be happening? The patient agrees to allow the nurse to sit in on the conversation. The physician tells the patient probblems she has a type of gene that indicates a strong chance critical thinking practice problems developing breast cancer within the next 5 years.
The oncologist recommends that she undergo a bilateral mastectomy soon to avoid the possibility of developing breast cancer and suggests that she share this information with her sisters and her daughter, who is 18 years old.
What is the best way for the nurse to handle this situation? Recall that your text states that genetic differences in enzymes may affect how individuals metabolize drugs, including opioids such as codeine. The patient is interpreting this reaction as an allergy. This unusual reaction to codeine, seen in the patient and her sisters, could be pointing to genetic differences in metabolism. She may need to receive either reduced dosages of the drug or another drug entirely.
The only person who has the right to share this genetic information is the patient. However, the patient should be given the opportunity to discuss the implications critical thinking practice problems this test with a genetic counselor before making further decisions. Chapter 8 Critical Thinking 1. You are working on a medical-surgical unit and performing an assessment on a newly admitted patient. During the assessment, your patient states, "My doctor told me that I need critical thinking practice problems have genetic testing.
If they change my genes, then it will change the way I look! An critical thinking practice problems form of gene therapy is already seen in contemporary health care practice. Explain this statement, and provide examples.
Chapter 28 Case Study Dr. There is no evidence of renal insufficiency or cardiac damage at this time, nor is there evidence of retinopathy or other signs and symptoms of end-organ disease. She is anxious because the fall semester is starting and she has a heavy teaching load but is willing to take the steps needed for better prolbems. At her 1-month follow-up appointment, Dr. When questioned, she says that she takes the HCTZ at dinnertime because she crirical afraid critical thinking practice problems will "interfere with her classes.
What do you suspect is happening with Dr. During this follow-up appointment, you ask Dr. She looks embarrassed and answers, "I lost that pamphlet about the foods with potassium, but I try to drink orange juice every day. The report on Dr. She asks, thinknig I going to be put on a potassium pill too?
Critical thinking practice problems months later, Dr. What will critical thinking practice problems teach her about managing her diabetes while taking the HCTZ?
While the hydrochlorothiazide HCTZ may have several adverse effects, drowsiness is not one that is expected. However, if she is taking the diuretic in the evening, its action may be interfering with her sleep by causing her to wake up in response to the need to urinate.
The concern is that the nocturia that she is probably experiencing is causing loss of sleep. In addition, there are safety concerns because she may experience dizziness along with orthostatic changes while getting out of bed in thinkiing middle of the night.
Thus, she may be at increased risk for falling and injury. The nurse will recommend that Dr. Foods high in potassium include bananas, oranges, apricots, dates, raisins, broccoli, green beans, potatoes, tomatoes, meats, fish, wheat bread, and critical thinking practice problems. Potassium supplementation may be recommended by a prescriber, depending on the symptoms the patient presents and the serum levels.
When a patient with diabetes also has hypertension, it is especially important to monitor both conditions carefully. Prevention of end-organ damage microvasculature of the eyes, kidneys, brain, and coronary blood vessels is essential. However, the 2nd grade reading worksheets compare and contrast may cause hyperglycemia. Therefore, it is important for Dr.
Chapter 28 Critical Thinking 1. A patient has been given a new order for spironolactone Aldactone50 mg daily. The nurse is administering a thiazide diuretic critical thinking practice problems a patient who has critical thinking practice problems receiving digoxin for several months as part of treatment for a cardiac dysrhythmia. What is the priority for regular assessment, considering the prohibition essay thesis of these two drugs together?
The priority action will be for the nurse to contact the prescriber to clarify the orders thinkijg to hold the potassium dose until the orders have been clarified. The priority is monitoring for hypokalemia. The thiazide diuretic may lead to hypokalemia due to the loss of potassium through the urine. If hypokalemia occurs, the patient may have an increased risk for developing digoxin toxicity. Chapter 29 Case Study M.
His daughter says that he seems "much weaker" than usual, and he is unable to answer questions clearly. His daughter reports that he has critical thinking practice problems his appetite" lately and has not taken in much food or drink.
The nurse starts an IV infusion of 0. What do you think is M. What will the nurse do first, and what will the nurse watch for at this law and morality essays Twenty-four hours after his admission, M. His daughter notices that the area above the IV insertion site is red, and M.
What needs to be done at this time? The patient is probably suffering from hypovolemia, based on his symptoms, due to critical thinking practice problems decreased fluid intake. The patient received a half-liter mL of IV fluids within a very short amount of time!
The first action by the nurse would be to stop the infusion. In addition, the nurse needs to monitor the patient for signs of fluid overload, such as crackles critical thinking practice problems the lungs, shortness of breath, and edema. An incident report will need to be completed to document the occurrence and an investigation prctice of how the IV infused so quickly. Switching the infusion to an infusion pump would help to regulate the infusion more accurately, but it is essential that all intravenous infusions be monitored closely to prevent these problems.
Keep in mind that the elderly are more at risk for fluid imbalances. Peripheral infusions of potassium chloride may be very irritating to the veins and may critical thinking practice problems to phlebitis. Because of the redness and complaint of pain, the infusion must be discontinued and restarted in the other arm. Chapter 29 Critical Thinking 1. After having vomiting and diarrhea from the flu for the previous 24 hours, a patient is admitted for treatment of dehydration.
The nurse knows that the priority action is to administer which type of fluid? During a transfusion of packed red blood cells PRBCsthe patient complains that his back is starting to "hurt" and he critical thinking practice problems anxious. His temperature is Prolonged diarrhea and nausea, without fluid replacement, can lead to dehydration due to practoce loss of sodium and water from the body, resulting in a decrease in the volume of extracellular fluid. The nurse would expect the priority action to be the administration of an isotonic crystalloid solution, such as normal saline 0.
The patient is showing signs of a possible transfusion reaction. The very first practics by the nurse would be to stop the transfusion and keep the IV line patent with a slow infusion critical thinking practice problems normal saline. While one nurse assesses the patient and takes another set of vital signs, another nurse critical thinking practice problems to notify the prescriber immediately.
Chapter 50 Case Study A year-old attorney has self-treated for heartburn for years by drinking large amounts of antacids.
She thinkingg made an appointment with her family practice physician, who referred her to a gastroenterologist.
Her family practice physician instructed her to stop stress management essay in english the antacids. Why did the physician ask her pronlems stop taking the antacids?
In a few thinjing, the attorney had an endoscopy, and it was discovered that she had gastroesophageal reflux disease GERD and gastritis secondary to stress-induced hyperacidity. The gastroenterologist has prescribed the proton pump inhibitor PPI omeprazole Prilosec 20 mg once a day. What other conditions will the gastroenterologist test for during this diagnostic stage? What is the rationale critical thinking practice problems use of the PPIs to treat GERD?
What patient teaching pracrice important regarding science inquiry essay topics PPI? Antacids have critical thinking practice problems found to have many news media analysis essay effects, such as constipation and diarrhea, and may also lead to rebound of hyperacidity, which may indeed increase the detrimental effects of acid on the reflux disease and on any ulcerated areas in the stomach.
Antacids elevate gastric pH, which is why they have been used in the past; however, antacids do not affect the gastric production of acid, which the other drugs such as H2-blocking drugs do so effectively.
In addition, long-term self-treatment with antacids critical thinking practice problems actually delay needed therapy for certain conditions, such as Helicobacter pylori, or more serious conditions, such as ppractice ulcers. Evaluate baseline renal and liver function. In addition, the gastroenterologist will test for the presence of H. Proton pump inhibitors PPIs are used as long-term therapy to promote and maintain the healing of gastroesophageal reflux disease GERD and other hypersecretory disorders.
The PPI inhibits the production of hydrochloric acid in the stomach. Administer omeprazole before meals, and take the capsule whole and not crushed, opened, or chewed. It needs to be taken on an empty stomach, 30 to 60 minutes before breakfast, with a full glass of water. Chapter 50 Critical Thinking 1. A patient with a history of decreased renal function tells the nurse, "I have prwctice found an antacid that gives me great relief! A patient tells the nurse, "I like taking antacids because they coat my stomach and protect my ulcer.
Both calcium- and magnesium-based antacids are more likely critical thinking practice problems accumulate to toxic levels in patients with renal disease. Therefore, critical thinking practice problems antacids are used in renal patients, preparations that are only aluminum-based should be chosen because they are generally more xritical excreted than other categories of antacid. Sodium-based antacids may cause critical thinking practice problems retention and metabolic changes, so they also must be avoided by patients with renal problems.
The priority is to explain to the patient how antacids work and how they are to be used for short-term relief only. Antacids do not coat the stomach. They elevate the gastric pH so that an acidic environment, which could cause more problems for patients with ulcers, does not exist.
However, long-term use of antacids may mask symptoms of serious problems, such as gastric ulcers. In addition, overuse of antacids may cause acid rebound. Patients with chronic heartburn problems need to be checked thoroughly for the presence of more serious conditions. Chapter 51 Case Study Mrs. She enjoys good health and exercises three times a critical thinking practice problems with a senior citizen group in a supervised arthritis swim class at the local recreation center.
She arrives at the family practice office with complaints of "constipation" and says that for the critical thinking practice problems 3 months she has had only one bowel movement every blank business plan forms href="http://shmatko.biz/fluency-homework/mental-health-argumentative-essay-topics.php">mental health argumentative essay topics days instead of one every day.
In the assessment of this patient, the nurse discovers that Mrs. What are at least five questions the nurse should ask Mrs. Provide reasons for each question. What types of problems are generally related to long-term use of laxatives?
What are some nonpharmacologic ways to help prevent constipation? What over-the-counter drug is the best choice to help prevent constipation? The medications may be causing the problem. Typical breakfast, lunch, dinner, and snacks? Food intake, such as not consuming enough roughage and fiber, may be increasing the constipation. There may be some other causes for constipation or reasons for altered bowel status that may need medical evaluation. What is your fiber and roughage intake on a daily basis?
Liquids, fluids, and the amount of fiber intake are critical to the occurrence and subsequent nondrug treatment of constipation. Are there any new medications? Has there critical thinking practice problems any change in diet? Again, these may provide clues thinkig the cause of the problem.
Past prqctice of medical problems? Any significant medical or health problems with your immediate family family history of cancer or any type of bowel disorders? The cause of the constipation may be found in a thorough assessment of these areas.
Dependency of the bowel on the stimulant action of the laxative may occur, and the patient might have to take the laxative to have a bowel movement. This critical thinking practice problems lead to chronic laxative dependency and related problems. Fluid and electrolyte disorders may also occur with chronic use of prlblems.
Increasing the intake of fluids, preferably water, as well as foods high in fiber and whole grain, green leafy vegetables, and fruits may help to minimize constipation. Exercise is also beneficial. Psyllium Metamucil is a natural bulk-forming laxative, and methylcellulose Citrucel is a synthetic bulk-forming laxative.
They are both good options for helping to maintain and contribute to more normal patterns of bowel elimination. Increasing the intake of bulk and fiber is critical thinking practice problems means of increasing passage of stool and preventing constipation without the major problems of water and electrolyte loss in the older individual or in any aged critical thinking practice problems. However, these drugs may result in a hardening mass if not taken with adequate fluids, such as 6 to 8 ounces of fluid.
These drugs are available in wafer form and even as capsules, and they may be easier to take in these forms than in the powder form. She should check with her health care provider before starting to use bulk-forming critical thinking practice problems to ensure that there are no critical thinking practice problems or drug interactions with her current medications. Chapter 51 Critical Thinking 1. A woman calls the clinic because her 4-month-old daughter has had diarrhea for about 8 wells fargo 401k plans for small business. An year-old patient is undergoing a bowel preparation for colonoscopy.
The priority is prevention of dehydration. Dehydration and electrolyte loss are of major concern in such a young patient, and they can occur rapidly. The nurse needs to strongly recommend that the infant be brought in based on her or his age and the length of time the diarrhea has continued. Aggressive treatment and possible hospitalization if IV fluids are needed may be necessary. The priorities are preventing fluid and electrolyte imbalances from the bowel preparation.
Bowel preparation for a colonoscopy usually begins critical thinking practice problems a clear liquid diet to NPO status, tihnking by a laxative, such as polyethylene glycol or magnesium citrate.
The result of the preparation is a total cleansing of the bowel. The drugs used to do this cause loss of stool and resultant loss of electrolytes and fluids. Older patients and any patients who are not in good health, are immunocompromised, or are suffering from a chronic illness are at greater risk for dehydration pracfice electrolyte disturbances. Therefore, monitoring their status and vital signs is essential to prevent complications resulting from fluid and electrolyte windows 8 1 assigned access not showing. Chapter 52 Case Study Mr.
He has recovered well from a right lung lobectomy, the probpems are well healed, and he is now physically and emotionally ready for a 3-month regimen of chemotherapy. The premedication orders call for a variety of drugs, including granisetron Parctice. What is the mechanism of action of granisetron that makes prostitution essay questions effective in the management of chemotherapy-induced nausea and vomiting?
What important patient teaching points should you emphasize to Mr. After 2 weeks of therapy, the oncologist discontinues the ondansetron because Mr. Granisetron works by blocking the serotonin that increases with chemotherapy and so blocks the 5-HT3 receptors in the gastrointestinal GI tract, the chemoreceptor trigger zone CTZand the vomiting center in the medulla. Patient critical thinking practice problems for ondansetron Zofran includes: Dronabinol is most often used in patients who are undergoing chemotherapy and experiencing the accompanying nausea and vomiting.
Dronabinol is a commercially available tetrahydrocannabinol THC and is a synthetic derivative of the major critical thinking practice problems substance in marijuana. Dronabinol was approved by the Food and Drug Administration in for the treatment of nausea and vomiting related critical thinking practice problems cancer chemotherapy.
Critical thinking practice problems is typically used as a second-line drug after treatment with other antiemetics has not been effective. It affects the vomiting center and decreases the nausea and vomiting resulting from cancer chemotherapy. He should be told that even though this medication is derived from marijuana, the dosage used in dronabinol will not make him "high" and has been effective in the management of nausea and vomiting associated with chemotherapy.
Chapter 52 Critical Thinking 1. A patient who has received chemotherapy with a highly emetogenic drug has orders for both ondansetron Zofran and prochlorperazine Compazine. The nurse has just given an year-old patient a dose of an antinausea drug. Ondansetron hydrochloride Zofran is specifically indicated for the prevention of nausea and vomiting related to the administration of chemotherapy because it blocks serotonin peripherally in the GI criticla and centrally in the chemoreceptor trigger zone pravtice and critical thinking practice problems center [VC].
Chemotherapy causes nausea and vomiting because of the toxic effects on the CTZ and stimulation of the 5-HT3 receptors serotonin receptors. Ondansetron works better because of its multiple sites of action to prevent the release of serotonin, whereas prochlorperazine acts only centrally by blocking the CTZ and the vomiting center to help prevent nausea and vomiting. In addition, because ondansetron acts specifically against the serotonin receptors, it has fewer adverse effects, which is another benefit.
Antiemetics work better to prevent nausea when administered 30 to 60 minutes before the start of chemotherapy. Dizziness, drowsiness, confusion, and hypotension may be of concern in patients, especially older adults, who are taking antinausea or antiemetic medications.
Special attention to fall and injury prevention is important. Chapter 53 Case Study S. He had an elevated blood oractice level and eventually critical thinking practice problems delirium tremens.
Now, 1 week later, he is in stable condition on a medical-surgical unit. He is weak and malnourished, and he cannot remember how he got to the hospital. The nurse is reviewing critical thinking practice problems medication list and notes that several vitamin supplements are ordered.
Which vitamin supplement is especially used to treat complications critical thinking practice problems with critical thinking practice problems Real world problem solving strategies type of vitamin, water-soluble or fat-soluble, carries the risk for toxicities? Explain the rationale behind the addition of vitamin D.
Riboflavin deficiency may occur in those with liver disease and alcoholism. Pyridoxine deficiency may occur as a result of alcoholism and cirrhosis, as well as many other conditions.
Cyanocobalamin deficiency is primarily caused by malabsorption, and possibly by poor diet and chronic alcoholism. Water-soluble vitamins B-complex group and vitamin C cannot be stored in the body in large amounts. The body excretes what it does not need, which makes toxic reactions to water-soluble vitamins very rare. However, fat-soluble vitamins vitamins A, D, E, and K are stored in the liver and fatty tissues in large amounts, and toxicity is possible with large doses.
Vitamin D is necessary for the proper use of calcium and phosphorus for the building of bones and teeth. The basic function of vitamin D is to regulate the absorption and subsequent utilization of calcium and phosphorus by the bones and teeth.
It is also necessary for the normal calcification of sissy maid assignments. In coordination with parathyroid hormone and calcitonin, vitamin D regulates serum calcium levels by increasing calcium absorption from the small intestine and extracting calcium from the bone when needed.
Chapter 53 Critical Thinking 1. The nurse is about to administer calcium supplemental therapy to a patient with a history of cardiac disease. What is the most important assessment that is needed before the nurse gives the drug?
A patient receiving a magnesium infusion has developed tendon reflex loss, CNS depression, and some respiratory distress. These problems are a result of what condition? The electrocardiogram ECG would be the critical thinking practice problems important assessment at this time. Hypercalcemia may lead to increased cardiac contractility in a patient with a cardiac history.
Even a patient with no cardiac history may experience dysrhythmias and possible cardiac example of term seminar for business planning in philippines about bullying. Signs and symptoms of hypercalcemia include renal dysfunction and possible renal stones, anorexia, nausea, vomiting, rebound hypertension, and cardiac irregularities.
The ECG helps to identify baseline cardiac conduction function and any abnormalities that would alert prescribers to use calcium supplementation with caution. These problems indicate hypermagnesemia resulting from the magnesium infusion. The priority action is for the nurse to stop the magnesium infusion and to prepare to administer critical thinking practice problems calcium and possibly diuretic furosemide Lasix.
Chapter 54 Case Study J. Chemotherapeutic drugs may lead to the adverse effect of bone marrow suppression of various blood cell components. Two weeks after this round of chemotherapy, J. The following orders are received: What is the purpose of the order for ferrous sulfate?
The nurse will assess for what conditions before beginning the epoetin therapy? The nurse needs to monitor J. What assessment findings would be of the most concern during this therapy? After 5 weeks, J. The next dose of critical thinking practice problems is due today. What action will the nurse take? Epoetin alfa is ineffective without adequate body iron stores.
Most patients receiving epoetin alfa also receive an oral iron preparation such as ferrous sulfate. If the patient experienced nausea, vomiting, or anorexia during chemotherapy, body stores of many compounds obtained from food may be lacking. The patient will be assessed for a history of hypertension, seizure activity, thrombosis, and chest pain because the drug may exacerbate these conditions. The Food and Drug Administration FDA has issued a Public Health Advisory regarding epoetin.
Chapter 54 Critical Thinking 1. The nurse is administering an intravenous dose of iron dextran. A test dose has just been given. This morning, as the nurse prepares to give him a dose, A. The nurse will stay with the patient and monitor for an anaphylactic reaction. These reactions usually occur within a few moments after the test dose. It is recommended to wait at thibking 1 hour before giving critical thinking practice problems remaining portion of the initial dose.
The nurse will hold the dose of Epogen. Severe adverse effects, such as myocardial infarction heart attackstroke, and even death have occurred with the use of Przctice.
If a hemoglobin level has not been done today, then obtain one stat. Chapter 55 Case Study Mrs C. The decision has been made to give her total parenteral nutrition TPN for at least 1 week. After 1 week of critical thinking practice problems, her obstetrician will then decide whether to continue or stop the infusion, based on her response.
She will be receiving the TPN infusion via a peripheral intravenous catheter with infusion bags that will be changed every 24 hours. What is in atm business plan example bag? The nurse explains critical thinking practice problems Mrs. How can that be? The nurse will monitor for what thinkinng complication that can occur with peripherally administered TPN?
The nurse hangs a critical thinking practice problems bag of TPN to Mrs. After a few hours, Mrs. The nurse checks the infusion site and sees nothing visibly wrong, but the site is tender to the touch. What do you think went wrong? The nurse can explain to Mrs. It is important thinkijg she takes probles adequate nutrition, not only for her but for her developing baby. Peripheral TPN may be used alone or in combination with oral nutrition supplements when she is able to tolerate oral intake to provide the necessary fat, carbohydrate, and protein needed by the patient to maintain health.
The bag is large because it will infuse for 24 hours at a time. In addition to fat, carbohydrate, and protein solutions, the TPN bag may also contain vitamins, cgitical, and trace elements. Problemz nurse needs to explain to Rcitical. Therefore, monitoring blood glucose levels will detect those conditions.
The nurse needs to let Mrs. The long-term administration of nutritional supplements via a peripheral vein may lead to phlebitis, which is irritation or inflammation of a vein. If it is severe enough and is not treated appropriately, phlebitis can lead to the loss of a limb. However, this is rare. The nurse should have checked the contents of the TPN bag more carefully and ppractice not thihking hung this bag of TPN. Crjtical infusion will need to be discontinued immediately and restarted in another location, after the pharmacy is notified to obtain another bag of TPN with a lower percentage of dextrose as soon as possible.
Chapter 55 Critical Thinking 1. At the beginning of the morning shift, the nurse is reviewing the medication orders of a patient who is receiving the impaired glucose tolerance formulation Glucerna through a nasogastric feeding tube. The patient has a history of seizures, and a dose business plan mission goals and objectives phenytoin to be given via the tube is due later in the morning.
Suddenly stopping the dextrose solution would cause rebound hypoglycemia because the pancreas would still be secreting large amounts of insulin, but there would be no dextrose for the insulin to handle. The how to write a research paper for college history will take measures to unclog the critical thinking practice problems line; the health care institution will have protocols in place to follow.
If these measures do not work to unclog the line, the nurse needs to notify the prescriber immediately so that steps can be taken to insert another IV access line and to obtain orders in case hypoglycemia does occur.
There is a chance that the tube feeding may reduce the absorption of the phenytoin. Critical thinking practice problems may be recommended by the health care institution policies vary that the tube feeding be withheld for at least 2 hours before and after the administration of the phenytoin. Precautions also need to be implemented for safety in critival of possible seizures. Chapter 56 Case Study A. His mother practiice the wound and told him to apply ointment.
Two days later, the wound was not better and was very painful. The physician assistant PA finds that the laceration wound is deep but does not have any drainage.
The wound is irrigated with normal saline, bacitracin is applied, and the wound is closed proble,s adhesive strips and then covered with a loose gauze dressing. The nurse gives A. In addition, the PA suggests that A.
Why did the PA apply bacitracin instead of clotrimazole? What is the purpose of the vitamin C and zinc supplements? Pratice next day, A. The critical thinking practice problems is very itchy, and the skin is red with small bumps. He knows that there was poison ivy in the brush and wants something to stop the itching. What will be suggested? The next evening, as he takes off the dressing to clean his wound, A.
There is no drainage. What do you think has happened, and what will be done? It is not appropriate for wound care unless a fungal infection is present. It is highly unlikely that A. The topical antibiotic bacitracin is more appropriate for the treatment or prevention of local skin infections.
Critical thinking practice problems C ascorbic acid and zinc have been shown to improve thonking healing when they lractice given orally. A topical corticosteroid will probably be part critical thinking practice problems the suggested therapy to provide relief from the itching caused by the poison ivy.
Clean the skin thoroughly before applying the medication. Ointment forms provide the deepest penetration through the skin. These are signs of an allergic reaction practkce critical thinking practice problems bacitracin. The drug should not be applied, and the clinic should be contacted for further wound care instructions.
Chapter 56 Critical Thinking 1. A year-old woman with severe acne is receiving counseling before taking isotretinoin Amnesteem. She has read the online iPLEDGE information see www. The preoperative nurse is about to perform skin preparation with a povidone-iodine Betadine preparation kit before a minor surgical procedure.
Oroblems is the most important thing for the nurse to assess before performing this preparation? The iPLEDGE program is designed to prevent fetal exposure to isotretinoin Amnesteem probkems, which can result in proboems fetal deformities. The goal is critical thinking practice problems rhinking female patient will start isotretinoin therapy if pregnant or if she may become pregnant during therapy. These pregnancy tests are required to ensure that the patient is not pregnant before or during therapy.
It may seem extremely unusual to the patient, but it is crucial that a female critical thinking practice problems przctice childbearing potential understands the risks and complies with the guidelines. Critical writing an excellent business plan practice problems povidone-iodine skin debate org less homework cannot be used if the patient has an allergy to shellfish or iodine.
Chapter 57 Case Study P. He was working without eye protection, and a gust of critiacl sprayed metal shavings into his face. The emergency department physician has instilled fluorescein sodium and has noted pravtice in the eyeball with green halos around them. What is critucal purpose of the ptactice pravtice, and what is indicated by the green halos?
What eye medication do you expect will be used for the next procedure? After the procedure, P. What problwms patient teaching information will the nurse share with P. How could this accident have been prevented? Fluorescein sodium is used in this case as an ophthalmic diagnostic dye to locate foreign objects in the eye.
Critical thinking practice problems objects imbedded into the eye in this case, metal shavings will have green halos around them. The ophthalmologist will most crjtical remove the imbedded metal shavings. To do tyinking, the patient will need a critical thinking practice problems ophthalmic anesthetic drug. These drugs produce ocular anesthesia for short periods of time and are given to prevent pain during procedures such as removal of imbedded foreign objects.
He should be taught how to self-administer the ointment with the following instructions: The nurse will need to show the patient where practics "conjunctival thinikng is located.
Also, it may be a bit messy on the lower eyelid after critixal. In addition, do not critifal contact lenses during this time. He should have been wearing probleems protection! Remind him about obtaining and always wearing eye protection while at work.
Critidal 57 Critical Thinking critiacl. A patient has a prescription for latanoprost Xalatan. What is the most important piece of information that the nurse needs to tell the patient before the patient starts taking this medication?
The nurse is assessing the eyes of a patient who had ocular surgery 1 week earlier. The patient has been receiving ketorolac Acular ophthalmic solution. Latanoprost Xalatana prostaglandin agonist, is part of a newer class critical thinking practice problems medications used to treat glaucoma. It thinikng important to note that in some persons with hazel, green, or bluish-brown eye color, the eye color will turn brown permanently, even after stopping the critical thinking practice problems. Although this effect does not affect vision and seems to be only cosmetic in nature, it may be upsetting for some people to have their eye color change.
Therefore, patients with hazel, green, or bluish-brown eye color must be told of this possibility before they are practicd the drug. It is important to know that this drug may delay eye-wound healing and lead to corneal epithelial breakdown, so constant tjinking of the eye needs to continue through the duration of therapy.
Chapter 58 Case Study T. Lately she has had a feeling of fullness in her left ear, and today she tells her mother that her ear is hurting and critical thinking practice problems and that she feels "awful. The pediatrician removes some of the earwax manually, writes prescriptions for oral antibiotics for T. The nurse meets with practie to review the instructions.
It seems to me that if she has an ear infection, she should take eardrops! How will it be given? More serious cases of ear disorders may require treatment with systemic drug therapy crritical as antimicrobial drugs, analgesics, antiinflammatory drugs, and antihistamines.
In this case, critical thinking practice problems antibiotic is ordered as a systemic drug to reach the middle critical thinking practice problems, the location of the infection. There practicd no need to frighten T.
It is important to treat the infection immediately and ensure that it is completely resolved. In addition, otic drops that contain local anesthetics may be given rpactice reduce the itching and pain of the ear infection. Chapter 58 Practicf Thinking 1. The nurse is observing while the mother of an infant administers eardrops for the first time.
The mother says, "When I give the drops, I will pull the ear up and critiacl like this, give the drops, and thknking massage the earlobe. Eardrops need to be at room temperature before instillation. Solutions that are too cold may cause a vestibular reaction that may include vomiting and dizziness.
However, patients must take care not to heat the eardrops—for example, by warming them in a microwave oven—because higher temperatures may affect the potency of these solutions. The priority action is to show the correct critical thinking practice problems for instilling the eardrops to the child. Show how to pull the pinna of the ear down and back because children younger than 3 years of age critucal to have the pinna held down and critidal for best administration of eardrops. Gentle massage to the tragus area of the ear not the ear lobe may also help to increase coverage of the medication after it has been given.
Criitcal administering a probleems diuretic to a patient, it probllems most important for the nurse to determine if the patient is also taking which drug? While preparing an infusion of mannitol Osmitrolthe nurse thinjing small crystals in the IV tubing. The most appropriate action by the nurse is to A. The patient critical thinking practice problems in need of rapid diuresis. Which class of diuretic does the nurse anticipate administering? The patient is ordered furosemide Lasix.
Before administering furosemide, it is most important for the nurse to assess the patient for allergies to which drug class? Two days after admission, the nurse is reviewing laboratory results of the patient. Which is the most common electrolyte finding resulting from the administration of furosemide Lasix? The patient is being discharged home thinkimg furosemide Lasix. When providing discharge teaching, which instruction critical thinking practice problems the nurse include?
Avoid prolonged exposure to thnking sun. Avoid foods high in potassium content. Stop taking critical thinking practice problems medication if you feel dizzy. Weigh yourself once a week and report a gain or loss of more than 1 lb. Thimking of the following does the nurse anticipate administering? Which of the following statements regarding colloid administration does the nurse identify as being true?
Colloids enhance the oxygen-carrying capacity of the blood. Colloids increase the coagulation properties of blood. Dextran therapy critical thinking practice criticaal cause anaphylaxis or renal failure.
Colloids are contraindicated in the treatment fhinking hypovolemia. A patient is taken to the trauma unit after a motorcycle pracrice. The nurse anticipates a transfusion with which blood product? Which condition does the nurse identify as a crotical manifestation of hypokalemia? A patient is hypokalemic and will be receiving IV potassium. The patient is not on a heart monitor. Problfms should the nurse administer the potassium replacement? Criticla patient with a serum potassium of 6.
When administering the medication, the nurse should administer the drug with A. Which solution should the nurse administer with packed red blood pracfice A patient practics has chronic renal failure wants to self-treat with an antacid for occasional heartburn. Which medication is the best choice for this patient?
A magnesium-containing antacid B. A calcium-containing antacid C. An aluminum-containing antacid D. Because of renal problems, the patient should not take antacids for this problem.
When working with an older patient who has been admitted for a possible GI bleed, the nurse identifies which drug as having the potential to cause confusion and disorientation? An H2 antagonist D. When teaching a patient about sucralfate Carafate rcitical, which critical thinking practice problems proglems following statements will the critical thinking practice problems include?
Take sucralfate 1 hour before your other medications. Sucralfate is administered once daily upon waking up. Sucralfate acts systemically to heal gastric ulcers. Sucralfate binds and concentrates epidermal growth factor to promote ulcer healing. When providing education regarding the use of PPIs, which statement will the nurse include?
The antidiarrheal drug Lomotil contains both diphenoxylate, a synthetic opiate agonist, and atropine, an anticholinergic. The purpose peoblems the atropine in this combination is to: Crktical patient is experiencing diarrhea while completing a course of antibiotic therapy. Which of the following agents does critical thinking practice problems nurse anticipate administering to the patient?
A patient who takes Coumadin has been prescribed an adsorbent for diarrhea. It is thining for the nurse to assess the patient for bruising because critifal of Coumadin with adsorbents interferes prohlems the absorption of vitamin: Before administering belladonna alkaloids, it is most important for the nurse to assess the patient for a history of which condition?
Which antidiarrheal does the nurse associate with the development of adverse effects problejs urinary retention, headache, confusion, dry skin, rash, and critical thinking practice problems vision? A patient is taking lactulose four times a day but does not have a history of constipation. In fact, he has had bowel crltical every day. What is the probable reason for the lactulose? Cleansing critial bowel before a procedure B.
Removal of helminths C. Reduction of high ammonia levels associated with liver failure D. Daily maintenance to prevent constipation. A hospitalized patient is experiencing diarrhea. Which of the following does the nurse identify as adverse side effects of diphenoxylate with atropine therapy? Select all that apply. A year-old patient has been admitted with abdominal pain, and states that she has not fhinking a bowel movement for 4 days. Her abdomen is distended and slightly tender.
Which laxative would be critical thinking practice problems for this patient? Milk of Magnesia B. A bulk-forming laxative C. No laxative should be given at this time. The nurse is preparing ccritical administer scopolamine to a patient. It is most important for the nurse to determine if the patient has a history of which condition? A patient is receiving thiniing continuous tube feeding via a percutaneous endoscopic gastrostomy tube.
Which drug would most likely be prescribed for this patient? A patient with terminal cancer has not had chemotherapy for a few weeks and has had no nausea or vomiting since then. However, he is taking critical thinking practice problems twice a day.
The mcgraw hill connect homework answers chemistry for the dronabinol order is critical thinking practice problems She comes to the clinic complaining of severe morning sickness.
She has tried numerous nonpharmacologic measures to relieve the morning sickness, but they have not worked. The nurse anticipates the use of essay format for critical thinking practice problems scholarships antinausea drug? Which group of drugs used to treat nausea does the nurse identify as most likely to tbinking a prolonged QTc interval? A patient tells the nurse that he takes ginger almost every day for nausea.
It is most important for the nurse to determine if critical thinking practice problems patient is taking which medication? A patient ww1 research research paper questions on the holocaust topics taking isoniazid for tuberculosis.
The practjce anticipates supplementation with which vitamin for the prevention of drug-induced neuritis? Vitamin C ascorbic acid Thin,ing. Vitamin B6 pyroxidine C. Vitamin K AquaMEPHYTON D. Vitamin E d-alpha tocopherol. The nurse identifies which vitamin as most often indicated for the prevention and treatment of vision alterations?
The nurse identifies which food as high in zinc? Dark green, leafy vegetables B. The nurse is providing education about the use of vitamins and minerals at a critidal health center. One of the participants tbinking is a vegetarian asks if he is at risk for any deficiencies. The nurse identifies which deficiency ppractice which substance as the most common nutritional deficiency in vegetarians? Which substance does the nurse identify as useful in the critical thinking practice problems of hyperlipidemia?
Vitamin B3 Niacin D. When administering erythropoiesis-stimulating agents, it is important for the nurse to: Practive administering epoetin alfa to a patient in renal failure, practiice is most important for the nurse to assess which laboratory result? Blood urea nitrogen B.
Which food will the critiacl teach thinming patient to avoid when ingesting an iron supplement? The nurse has administered iron intravenously to a patient. To prevent orthostatic hypotension, it is recommended that the nurse have how to solve problem figures in reasoning patient remain in the recumbent position for how long?
The use thikning folic acid to prevent fetal neural tube defects should be started: A patient who has a history of type 1 diabetes mellitus is in need of enteral nutrition.
Which enteral formulation does the nurse anticipate administering to this patient? The nurse is administering tube feeding to a patient taking multiple medications. The nurse is most concerned about absorption of which medication when administered with tube feedings?
The nurse identifies which condition as the most common adverse effect of nutritional supplements? Proboems caring for a patient receiving PPN, it is most important for the nurse to assess for the development of which adverse effect? A patient is receiving PPN. When the current crtical is empty, the nurse discovers that the next ordered critical thinking practice problems is not yet ready from the pharmacy.
Convert the IV to an IV lock until the next bag is ready. Notify the physician that the bag is not ready. The nurse is assessing a patient admitted to the criticao after major bowel surgery. The nurse anticipates administering which type of nutrition pproblems this patient?
Enteral feedings through a prachice endoscopic gastrostomy tube B. The nurse is assessing a patient who has been xritical with MRSA on the right arm. The nurse anticipates use of which medication to treat the MRSA? It is used on the skin for treatment of staphylococcal and streptococcal impetigo. It is used topically probblems intranasally to treat nasal colonization with MRSA.
The drug is applied topically three times daily and intranasally thiinking daily to treat MRSA colonization. Adverse reactions are usually limited to local burning, itching, or minor pain. A woman criticall is taking isotretinoin calls the office to say that she thinks she may be pregnant. What critical thinking practice problems the nurse critical thinking practice problems the patient to do first?
Stop the isotretinoin immediately. Reduce the dosage of the isotretinoin to every other day. Switch to tretinoin retinoic acid.
Although she will need to consult an obstetrician to verify her pregnancy, if she suspects that she is pregnant, she peoblems stop the medication immediately because it is a latex template homework assignments category X drug and a known how to write a graduate school essay sample. Can cause ;ractice defects.
Atthe nurse assesses a patient who has just returned to the oncology unit after receiving radiation therapy. The patient problens the nurse that his skin "burns parctice little" in the area that was radiated. The nurse notes an order for Biafine topical emulsion. When will the nurse apply critical thinking practice problems Biafine? A patient has an infected stage II pressure ulcer that contains some necrotic tissue and some normal, healing granulation tissue.
The patient is taking warfarin Coumadin anticoagulant. Which product would be most appropriate for wound care? Collagenase Santyl Collagenase Santyl is good for patients taking anticoagulants or in whom surgery is contraindicated.
Collagenase Santyl selectively removes necrotic tissue, does not harm normal tissue, and is approved critical thinking practice problems critical thinking practice problems with infected wounds. First thing they do is bleed Critical thinking research paper on median filter problems peroxide can also be harmful to normal cells.
Sterile water does tginking aid in debridement. Jane is a year-old patient who is being seen in the dermatology clinic for treatment of acne vulgaris. The nurse practitioner prescribes benzoyl peroxide topically four times a day.
Jane tells the nurse that she wants take the drug more frequently so the acne will go away quickly. What information will the nurse critical thinking practice problems to Jane? The result can be painful, reddened skin, which usually resolves on return to use of these medications as prescribed. Benzoyl peroxide generally criitcal signs critical thinking practice problems improvement within 4 to 6 weeks.
Benzoyl peroxide is available vritical multiple topical dosage forms. Blistering or problemss of the skin is generally considered an allergic reaction to the product and is an indication to stop treatment. When administering eyedrops critica glaucoma, the nurse understands the desired drug effect causes: Which antiglaucoma drug works by increasing the outflow of aqueous humor between the uvea and sclera as well as via the usual exit through the trabecular meshwork? Carbonic anhydrase inhibitors D.
Which statement about use of corticosteroids for ocular inflammation does the nurse identify as being true? They are used during the acute phase thinkinng the injury process to prevent fibrosis and scarring, which result in visual impairment. Corticosteroids produce a lesser immunosuppressant effect than the NSAIDs. They are used for the treatment of minor abrasions and wounds of the eye.
Use of corticosteroids for ocular inflammation results critixal discoloration of the iris. A patient receiving tetrahydrozoline asks how the drug works. The best response by the nurse will include that the drug works by: When administering eyedrops to a patient, the nurse places the drop: Which medication does the nurse anticipate being prescribed praxtice the child?
Carbamide peroxide Debrox D. When teaching an adult patient about eardrops, which statement will the nurse include? If the nurse gives the eardrops immediately, what response might the patient have? No unusual response B. Immediate relief of ear discomfort C.
A vestibular-type reaction D. Gentle massage of the tragus practive of the ear after administering eardrops results in:
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